NPIMap

Organization Active NPI

Delta Gastroenterology P.C.

  • Specialist
  • Southaven, MS
National Provider Identifier
1285789677
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
DELTA GASTROENTEROLOGY P.C.
Practice address
9140 Highway 51 N
Southaven, MS 38671-1233
Phone
(662) 280-8222
Fax
(662) 280-5541
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ulric Duncan, M.D.NPI 1518908854
Title
Gastroenterologist
Phone
(662) 280-8222

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

9140 Highway 51 N
Southaven, MS 38671-1233

Mailing address

9140 Highway 51 N
Southaven, MS 38671-1233
Phone (662) 280-8222

Other identifiers 4

IdentifierTypeStateIssuer
3050626OtherTNBLUECROSS BLUESHIELD
3729898MedicaidTN
3050626OtherTNTENNCARE SELECT
3000117OtherTNTLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050428000948 MS Part B Supplier - Clinic/Group Practice 6800835893 Receives reassigned benefits from 5 practitioners
Practice locations: Ripley, MS; Senatobia, MS; Southaven, MS
O20050706000982 TN Part B Supplier - Clinic/Group Practice 6800835893 Receives reassigned benefits from 1 practitioner
Practice locations: Bartlett, TN; Memphis, TN

National Provider Directory

National Provider Directory

Locations

112 Northwest Plz
Senatobia, MS 38668
Phone (662) 562-8818

9140 Highway 51 N
Southaven, MS 38671
Phone (662) 280-8222

1867 Forrest Dr
Southaven, MS 38671
Phone (662) 280-8075

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2239/brand/1/csg/22/fhir/r4

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1285789677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9140 HIGHWAY 51 N",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711233",
            "telephone_number": "662-280-8222",
            "fax_number": "662-280-5541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9140 HIGHWAY 51 N",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711233",
            "telephone_number": "662-280-8222",
            "fax_number": "662-280-5541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DELTA GASTROENTEROLOGY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "DUNCAN",
        "authorized_official_first_name": "ULRIC",
        "authorized_official_title_or_position": "GASTROENTEROLOGIST",
        "authorized_official_telephone_number": "662-280-8222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUESHIELD",
            "identifier": "3050626",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3729898",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNCARE SELECT",
            "identifier": "3050626",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TLC",
            "identifier": "3000117",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.